HomeMy WebLinkAbout020-1034-60-200
o cn o K m 0 Q
v
m o (D -0
v m ~ ~
O
cr, z z V: O p O = CD
. t*r .
0 0 N (D O J O _ y+
p N rl
O N n p CD ~ .7
a N a N o O O
N C (D W p ? ~ W O
o -0 co 0
Q O N O NO O O
f/ ~
r-' N (Op
J
W
0 0 !D o ° D
N
z ~ n r cn
O ~ ~ O p C
0 0 a:,D-
0
0 O N~1 •
Z O O O
O = -p n < Z 5
v a I O _O c
p N CL ID EO N _
D1 N
ZJ CD
= O
C) ~ N -CC
N pSj ~ d G W
2 O. 7 CT1 N
Z z O
p Z co Z ~
O D d CD 0
t+
o C CD
m CD `we
N cn
z a)
11 N
C (D O
W (C Q
Q 7~ E
Z p t6 , -j N
O E3 A Z n
r cn
C r
Z O
A
CL
N
Q
Z -i
M N V
rD (D a z
A ~
O M M
o m ~
N z
(D A
W
N
N
X C
N p -
q n T
Q a G
O Z O
Q G
U
O
O
O
O
41
N f
(D
N V
~ v
a,
N
O
O
(^y y4 `•r
O (D
C) Q \ V
" WinoonrIn Departraant of Health and So^io"1 Sarvices
Plb. x67 3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION "2( 2 00
TYPE or USE BLACK INK
~SS I- -13,-J11 AC_ ~
A. OWNER OF PROPERTY
Name Address (Street, City, 'Lip Coda)
B. LOCATION OF PROPERTYW_ }'w..RE SY;TFM WILL BE CONSTMTED ALTERED OR EXTENDED COU111TY
Check One:
CITY VILLAGE LEGAL DESCRIPTION
TOWNSHIP T 9 c, + 1 f
tiz
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? ~ Iis NO PERMIT NUL'_BE.R
D. SEPTIC TAI;X CAPACITY /j1f ~2 Gallons NEW INSTALL.J1.TICY REPLACa ENT ADDITION
MATERIALS; Prefab Concrete Poured in Place Ste•.l _ Other
NUMBER OF TAhnS TO BE
NSTALLsD:
E. TYPE OF OCCUPANCY
Chrok One: One or Two Family Residence Coswercial _ Induotrial Other
(specify)
Number of Persons to be Accommodated Number of Badrocros
F. APPLIAN::ES, ETC: Food Waste Grinder _ YES NO Automatic Clothes Washer ES_ NO
Dishwasher -..4 YES NO Automatio Potato Peeler YESNO
Other (Speoif;)
G. MASTER PLUNDER MAKING INSTALLATICN
Lioonse Numbers
Fa_M..; •.3 Address:
477
Si -,-v tura of Applicant: MP RSW
Address:
/JL-I Ll ' 'f / /j, _r
!i. (To be Completed by Issuing Agent) f
Date of Application / 61" 7-/ '1-) Fee Paid
Permit Issued (date ® 7-17 Permit Number _
Agent (Name) Ford~k~°~'~ 1.Lil/
Tewn, Village, Ci y, County, etc.
(Specify)
Note; The application cannot be considered for filin3 until all of the above questions are answered and the
fee paid. Agents will forr"ard application, the fee of ;1.00 for each s5,)tio tanx and the third dopy '
of the permit (canary; to the Division o, Health. Checks w:d money orders should ba zade payable to
the D"ivision of Health.
Do not write in space below - FOR DEPARMENT USE ONLY
I. DATE RECEIVED A-CCEPTED BY RETURNED
(Initials) (Date) See Corres.)
FEE RECEIVED _ VALID. No. PERMIT NO. ?
Yes or No
REVIEWED BY APPROVED DATE
(Initials) Yes or No)
COMPLETE OTHER SIDE
SEPTIC TANK PERMIT NO.
R Y P 0 R T O N S O I L P Y R C 0 L A T I 0 N T E S T
A X D S O I L- B O R I N G S
TO
DIVISION OF HEALTH - PLU-MING SKCTI~3
P.O.Box 309, Madison, Wis. 53701
Pursuant to R 62.20, Wis. Adai.-,13t_ativ~ Code
P 8 R C 0 L A T I 0 N T& S T
Test Depth Character of Soi?F'!-;rs Hater Tea', Tirse Dro in Water Level Incises ute.
N=bor Inches Thickness is Inches I Since Role in Hole Interval Second -so Neat to Last To Fall
I ist Vatted Over.i ht in tiinu-Lei Last Pa?iod Iasi Period Period Cna, Inch
ExaMple
P - 0 361, Top Soil 10". .SAV 261° X25 Yes or No 30 1 2 1/2 1/2 50
-42
~-F---
RECORD DATA FROM MR4D1Ri 0? 3 nST HOLSS
Compute size of absorption area in accord with H 62.20 Wis. Administrative Code.
S O I L BORING 5 - Mini°aza 3f" Be_L P:o ova !?sermon 5u~at.~
Boring Total Depth Depth to ;;round 'at.-r Da th to Bedroct
Number Inches C,bservod Ast;ratod 0~served Esti~zt 1 Character of Soil with Thiol*,Yiess in 1rch-,e
Example
B - G 7219 72" Black Town Soii 12111 Clay 18111 Sand 3,811; Gravel 24"i
^R€-,13.9D DATA FROM MIN1'IUM 0? 3 BCRv
YPE OF OCCUPANCY:
RESIDENCE: Number of Bedroa:4 sJ OTHER: (Specify) Number of Persons
FOOD HASTE GRINDEx: Yes No Dis : ashy^: Yea No Rutosatic Cloths Washer: Yes No
EFFLUENT DISPOSAL SYSTEM: Ned r EXTENSION ADDITION Re^PL"C~.ir_iT
.s
Tile Size No.Lin.Fast Tranch Width Depth Number of Lines
Seepage Bed: Length Width 52 O Depth ( Tile Size ,f No. Lines
Seepage Pit= Inside Diameter Liquid Depth
I, the undersigned, hereby aerti y that the perooLation tests reported a this for= were made by me or under % "per-
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Adainistrative Code, and
that the data recorded and location of test holes are correct to the best of my knowledge and belief.
NAM c f~AiQ ) Z P K/G~ TITLE /
Type or Print
REGISTRATION NO. _ or MASTER PLUMBER LIC ISB NO.
ADDRESS e- i!
DATE ICJ Z SIGNATURE
Parcel 020-1034-60-200 05/18/2007 04:03 PM
PAGE 1 OF 1
Alt. Parcel 17.29.19.149A-20 020 - TOWN OF HUDSON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - OESTREICH, ROBERT & BARBARA
ROBERT & BARBARA OESTREICH
955 TROUT BROOK RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description " 955 TROUT BROOK RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 12.820 Plat: 4312-CSM 16/4312 020/02
SEC 17 T29N R19W PT NW SW & PT NE SE SEC Block/Condo Bldg: LOT 01
18 BEING LOT 1 CSM 11/3169 15.82AC NKA
LOT 1 CSM 11/3199(15.82AC) NKA CSM Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
16/4312 LOT 1 12.820AC 17-29N-19W NE SE
Notes: Parcel History:
Date Doc # Vol/Page Type
06/10/2002 681428 16/4312 CSM
07/23/1997 533/471
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 77,000 116,600 193,600 NO
PRODUCTIVE FORST LANDS G6 10.820 75,700 0 75,700 NO
Totals for 2007:
General Property 12.820 152,700 116,600 269,300
Woodland 0.000 0 0
Totals for 2006:
General Property 12.820 152,700 116,600 269,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00